BJA Advance Access originally published online on April 30, 2007
British Journal of Anaesthesia 2007 98(6):769-774; doi:10.1093/bja/aem097
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Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study
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1 Acute Medical Unit
2 Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN112DH, UK
3 School of Computing, Mathematical and Information Sciences, University of Brighton, UK
* Corresponding author. E-mail: richard.venn{at}wash.nhs.uk
Background: Several physiological scoring systems (PSS) have been proposed for identifying those at risk of deterioration. However, the chosen specific physiological values chosen and the scores allocated have not been prospectively validated. In this study, we investigate the relative contributions of the ventilatory frequency, heart rate, arterial pressure, temperature, oxygen saturation, and conscious level to mortality in order to devise a robust scoring system. All data were collected on admission to the emergency unit. Precise ‘intervention-calling scores’ could then be derived to trigger interventions.
Methods: Our observational, population-based single-centred study took place in a 602-bedded district general hospital. Patients admitted to the emergency care unit at Worthing general hospital during an initial study period between July and November 2003 (n = 3184) and a further validation period between October and November 2005 (n = 1102) were included.
Results: Multivariate logistic regression analysis demonstrated that a ventilatory frequency 
20 min–1, heart rate 102 min–1, systolic blood pressure 
99 mm Hg, temperature <35.3°C, oxygen saturation 96%, and disturbed consciousness were associated with an increase in mortality. The Worthing PSS was developed from the regression coefficients associated with each variable. The model showed good discrimination with an area under the receiver operating characteristic curve, 0.74, excluding age as a variable. The discrimination of this system was significantly better than the early-warning scoring system.
Conclusions: A simple validated scoring system to predict mortality in medical patients with precise ‘intervention-calling scores’ has been developed.
Keywords: critical illness, mortality; health status indicators, scoring system; medical admission; outcome assessment, methods; prognosis
Janene Holway, Kathleen Durick and Pat Kerry (administrative support) participated in data entry. J.W. and the Nursing staff (Emergency Admissions Unit) collected all the patient data. R.B.T., R.D., R.V., and L.F. participated in data entry and collection. R.V., L.F., R.D., E.C., and V.B. contributed to the concept, design, and implementation of the study. All authors contributed to the manuscript and read and approved the final version. All authors will act as guarantors for the paper.
This article is accompanied by Editorial II.
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